Thrombophilic polymorphisms - factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T - in Tunisian patients with cerebral venous thrombosis.

Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients.

[Epidemiology of domestic accidents of young children in Tunisia: impact of the training of health professionals on data collection quality]. / Epidémiologie des accidents domestiques du jeune enfant à Tunis : Impact de la formation des professionnels de santé sur la qualité de la collecte d'informations.

BACKGROUND: In Tunisia, several studies on domestic injuries have been carried out on children attending care facilities. Nevertheless,there is a lack of data on incidence and kinds of child domestic injuries amongst general population because of absence of a reliable data collect system. AIM: To estimate the incidence and kinds of domestic injuries through a prospective survey "here-there" within two cohorts of young children attending two mother and child protection centers (MCPC) in Tunis during the three first years of their life and to analyze the importance of health professional training in improving data collect. METHODS: A prospective study "here-there" was carried out on two cohorts of children in two mother and child protection centers (MCPC) between January 2007 and December 2009. Only children aged less than 3 months at their first contact with the centers were included and followed up until age of 3 years. In the MCPC2 (cohort2), health personnel have been trained on data collection importance related to child domestic accident and asked to monitor accidents by calling parents while a phone line got available for this aim. In the MCPC1, health personnel was asked to work as they used to do and to collect data on child domestic injuries when children attend the center. RESULTS: 192/435 domestic accidents were recorded within cohort 2 vs only 1/686 within cohort 1. Annual incidence rate was 14.7% for the cohort 2. The kinds of accidents were: falls 78.2% (falls from high plans 84.6%), injuries15.1% (injury by cutting things 58.6%),burns 5.7% (burns by hot liquid 54.5%), intoxications 1%. In terms of damages, we recorded 4 cases of broken bones (thighbone, elbow,handwrist), stitches in 11 cases, broken teeth in 3 cases and nail pulled out in one case. No death was recorded. Training impact on accident prevention was not studied. CONCLUSION: Child domestic accidents are relatively frequent. Health personnel training allows to improve data. The kinds of recorded accidents indicate the need to educate parents on best practices towards strengthening prevention.

HLA-B, DR and DQ antigens polymorphism in Tunisian patients with ankylosing spondylitis (a case-control study).

The objective of the study is to assess the distribution of HLA-B genes, HLA-B27 subtypes, HLA-DRB1 and HLA-DQB1 alleles in patients with ankylosing spondylitis (AS) and in control subjects in the Tunisian population and to compare their distribution with that found in other countries. This is a case-control study that included 100 consecutive patients (85 males/15 females) with AS according to the modified New York criteria and 100 control individuals. HLA-B, B27 subtypes and class II (DR and DQ) typing of all subjects was performed by polymerase chain reaction amplification with sequence-specific primers (PCR-SSP). HLA-B27 was found in 62% of patients against 3% in controls (P = 0.0000, OR = 52.6, 15.6 < CI < 166.7). On the other hand, B*07 and B*51 were significantly decreased in comparison with controls (P = 0.01, OR = 0.3, 0.1 < CI < 0.8 and P = 0.0000, OR = 0.2, 0.1 < CI < 0.4, respectively). Eight B*27 subtypes were identified in the AS group, but the most frequent ones were B*2702 (32%) and B*2705 (24%). Among HLA-DRB1 alleles, a significant increase in DRB1*11 was found in comparison with controls (P = 0.01, OR = 2.2, 1.2 < CI < 4.5). However, DRB1*13 had a negative association with AS (P = 0.01, OR = 0.4, 0.2 < CI < 0.8). For HLA-DQB1 alleles, a significant positive association with DQB1*03 was observed in AS group (P = 0.03, OR = 1.8, 1.0 < CI < 3.4). Multivariate analysis by logistic regression revealed that DRB1*11 and DQB1*03 had no direct links with the disease, but were dependent on the presence of HLA-B27. Moreover, B*07 and B*51 seemed to have independently a negative correlation with AS, but DRB1*13 seemed to depend on B*51. Haplotypes carrying B27 were significantly associated with AS and those carrying B*07 or B*51 were negatively correlated with the disease. In conclusion, our study confirms that B27 predisposes to AS while B*07 and B*51 are negatively correlated with the disease.

[A retrospective study of 339 ICSI cycles: assesment of the two first years of activity of the Assisted Reproductive Technology Center of Aziza Othmana Hospital]. / Etude retrospective de 339 cycles d'injection intra cytoplasmique de spermatozoïdes: bilan des deux premières années d'activité de l'unité d'assistance médicale à la procréation de l'hôpital Aziza Othmana.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) is a micromanipulation-assisted fertilization, whereby one spermatozoon is injected into the oocyte cytoplasm. Initially, ICSI was the treatment of choice for male factor infertility. However, because of the high fertilization and pregnancy rates achieved with this technique, the scope of the procedure has been widened to include couples with other causes of infertility. AIM: The aim of this study was to study the progression of the activity of the assisted reproductive technology's center of Aziza Othmana's Hospital and the ICSI results during the first two years. METHODS: Our study included 269 infertile couples who underwent 339 ICSI cycles between 1st May 2001 and 30 April 2003. Cycles with no oocytes obtained at the follicular aspiration and women aged over 40 years were excluded from this study. RESULTS: The number of ICSI cycles progressed in our center: 150 ICSI cycles in the 1st year, 189 ICSI cycles in the 2nd year. The mean number of picked-up oocytes was 8,8 +/- 5,6. The fertilization rate was 62%. The mean number of transferred embryos was 3,1 +/- 1,5. The pregnancy rate per transfer was 32,4%. The miscarriage rate was 28,4%. The take home baby rate was 67,9%. CONCLUSION: The number of couples undergoing ICSI cycles in our center is increasing. The fertilization rates and pregnancy rates in our center are similar to those published in the literature.

Validation of the Tunisian versions of Bath Ankylosing Spondylitis Functional Index (BASFI) and Disease Activity Index (BASDAI).

BACKGROUND: The Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity (BASDAI) are the most commonly used instruments to evaluate respectively functioning and disease activity in ankylosing spondylitis (AS). OBJECTIVE: The aim of this study was to translate, adapt and validate these instruments into the Tunisian language. METHODS: The studied population consisted of 68 AS patients (59 males and 9 females). Their mean age was 37.9 years (range: 18-76). The mean disease duration was 13.6 years (range: 1-40). After translation and retranslation the BASFI and BASDAI questionnaires were administrated to the patients and tested for reliability, internal consistency and construct validity. RESULTS: The reproducibility of the indices BASFI and BASFAI was good, the intraclass correlation coefficient for reliability was 0.96 (CCI:0.93-0.97) for the BASFI and 0.93 (CCI:0.90-0.97) for the BASDAI, and the coefficient of internal consistency (Cronbach's alpha) was 0.91 for BASFI and 0.90 for BASDAI. Concerning construct validity, both questionnaires were significantly correlated to each other, to the disease-specific instruments (BASG-s, BASMI, BASRI, ASQoL) and to all domains of the SF-36. CONCLUSION: The Tunisian versions of the BASFI and the BASDAI preserve the metrological properties of the original versions and were easy to use for the assessment of disease status in ankylosing spondylitis.

[Prevalence of benign prostatic hyperplasia in general practice and practical approach of the Tunisian general practitioner (Prevapt study)]. / Depistage de l'hypertrophie benigne de la prostate en medecine generale en Tunisie: etude Prevapt.

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH presents as lower urinary tract symptoms (LUTS). AIM: The aim of this study is to assess the prevalence of LUTS suggestive of BPH in 50 years or older men in general medicine and to evaluate the management of these patients by general practitioners. METHODS: This cross-sectional, prospective, multi-centre epidemiological survey, included all men with an IPSS (international prostatic symptoms score) > or =8. The management by general practitioners was analysed including complementary examinations and treatment. RESULTS: Among 4602 outpatients recruited by 88 general practitioners, 434 patients had an IPSS > or =8 and were included in the study. The prevalence of LUTS/BPH was 16.1%. The prevalence showed a linear increase with age. The prevalence was 7% at the age 50-59 years, 17.4% at the age 60-69 years and 33.4% in 70 years and over men. LUTS were the main reason of consulting general practitioner in 45.4% of cases. 72.6% of patients were with moderate symptoms (IPSS 8-19) and 26.4% of patients were with severe symptoms (IPSS 20-35). Quality-of-life score was 0-2 in 10.3% of patients, 3-4 in 52.2% of patients and 5-6 in 37.5% of cases. The management by general practitioner was then a watchful waiting in 14.7% of cases, to refer the patient to an urologist in 13.7% of cases, to ask for complementary examinations in 71.6% of cases and to treat in 73.4% of cases. Only 37.4% of patients with suspect prostate malignancy were referred to the urologist. In cases of treatment alpha blocker was the treatment choice in 77% of the cases. CONCLUSION: LUTS/BPH are frequent in Tunisia. It occurs in one third of men over 60 years and one fifth of men over 70 years. With the progressive ageing of Tunisian population, this pathology may constitute a public health problem. It is therefore urgent to elaborate recommendations concerning the management of this disease, specifying the role to play by the urologist and the general practitioner.

[Analysis of knowledge attitudes and practices of health care workers facing blood exposure accidents in a general surgery service]. / Analyse des connaissances attitudes et pratiques du personnel soignant face aux accidents d'exposition au sang en chirurgie generale.

In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35.7 years. The sex ratio is 0.7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood (95.6%), but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71.2% of investigated. The majority of investigated declare to know universal precaution principles (85.8%). However, to the maximum 4 measures only on the 10 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficiently known by our sample. It is represented, in 78.8% of cases, in the application of disinfectants Betadine type or alcohol iodized, whereas the practice of a serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months (n = 44) didn't declare their blood exposure accident and only 11.4% declare to have undergone cares. Actions of information and formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial.

[Cervical cancer screening by Pap smear: experience of the National Research Center in Reproductive Health. ONFP]. / Depistage du cancer du col de l'uterus par frottis cervical: experience du centre national de recherche en sante de la reproduction. ONFP.

We have analysed the result of 17,173 pap smears screened in the national research center in reproductive health of Ariana from 1 may 1993 to 30 april 1997. Among these pap smears, 613 colposcopy and 380 biopsy have been performed. The results show that: 1.9% of pap smears present cytological anomalies with 0.79% of low Squamous Intraepithelial lesions and 0.66% high Squamous Intraepithelial lesions. The incidence of CIN III is 1.8% and 0.9% for invasive cancer. The age interval 35-44 years is at high risk of CIN III and invasive cancer of the cervix. evaluation of our diagnostic approach shows that: positive predictive value of pap smears with low SLI is 43.2% positive predictive value of pap smears with high SLI is 37.3%.

[Risk factors of drug use in school environment in Tunis]. / Facteurs de risque de la consommation des drogues en milieu scolaire à Tunis.

The aim of the study was to estimate the prevalence of addiction and drug use among Tunisian school teenagers as well as the risk factors associated with this conduct. A transversal study of "Knowledges, Behaviors and Practices" (KBP) has therefore been conducted among 353 school teenagers in the area of Tunis by means of an anonymous and self administered questionnary. Pupils' ages range from 12 to 24 with as many boys as girls (51.6% VS 48.4%). Three quarter (3/4) of the pupils have heard of drugs, the cannabis ("zatla") being the most common referred to; nearly 13% of the pupils said they have consumed drug at last once, half among them more then 3 times. The risk factors associated with drug use are the male sex (p = 10-7), tobacco or alcohol consumption (p = 10-8), violent behaviors (p = 10-4) and a confactual situation with parents (p = 10-5). A prevention of the problem should be based on an action over the identified risk factors.

[Value of reagent strips in screening urinary infection in children]. / Intérêt des bandelettes réactives dans le dépistage de l'infection urinaire chez l'enfant.

The aim of this study is to specify the role of rapid tests in the screening of childhood urinary tract infection. During the period between july to december 1998, 572 urinary samples were collected from pediatric out-patient in Hôpital d'Enfants de Tunis and aged from 1 month to 15 years. Only 75 samples (12.5%) were culture positive. The predictive value of leucocytes or nitrites test was 97.2%. These results allowed the use of rapid test in the screening of urinary tract infection in children. However, if clinical symptoms are present, the culture of urine must be associated to the rapid test.